The Nipah virus currently attacking Kerala, India, is a highly contagious disease for which there is no treatment. It kills almost everyone it infects, but it also triggered action on by the Coalition for Epidemic Preparedness Innovations (CEPI).
Under CEPI, two pharmaceutical companies are fast tracking the creation of a Nipah vaccine. CEPI is also developing a new vaccine for Lassa fever, a disease endemic to West Africa that causes an estimated 5,000 deaths per year.
{mosads}We know for sure that there will continue to be infectious disease outbreaks, so organizations like CEPI are doing important work. Vaccines are a critical public health resource. But it is important to acknowledge that they are not a speedy, inexpensive, or fail-safe solution.
I spent over 25 years engaged in the development and market launch of vaccines and pharmaceuticals. Especially for a vaccine, it can be challenging to commit to the long and expensive development timelines. A crisis can sometimes tip the scales. However, even when there is financial commitment, time and resource requirements are also enormous – and not just on the part of the developer.
We have known about Nipah for nearly two decades. The first identified outbreak was in Malaysia in 1999, and there have been nearly annual outbreaks in Bangladesh since 2001. While CEPI’s five-year funding commitment to research and development of a vaccine is a great start, any results of that work will be too late for those in the epicenter of the current outbreak.
Even for outbreaks with excellent vaccines, supplies cannot always be ready fast enough. Once supplies are ready to bring to market, they still need to be fitted into the supply chain, stored properly, and transported to the appropriate individuals — wherever they are.
The logistical issues can be enormous. We are seeing those issues with the experimental Ebola vaccines in the Democratic Republic of the Congo now as aid workers use small boats or motorbikes carrying portable freezers of vaccine to reach remote villages. Vaccines must be administered properly. That means recruiting and training medical professionals and educating the public so that people seek out and receive a vaccine. It also means tracking doses and side effects.
This is why preparedness is vital. Vaccines have a very specific function for containing disease. But even if we develop a vaccine for every possibility, they still have limitations. Local communities must therefore be prepared to prevent and contain outbreaks and limit the impact of those outbreaks on health care and public services.
Preparation means having comprehensive, resilient primary health care services and systems in place with working components: strong leadership, engaged communities, laboratories and hospitals, pharmaceutical systems, supply chains, and disease surveillance systems.
Disease outbreaks start and end at the community level, so focusing efforts there is critical. At the global health nonprofit where I work, Management Sciences for Health, we help local authorities develop preparedness plans so that leaders know how to react, communicate risks and lead residents in adopting preventive behaviors.
In Madagascar, with USAID we trained and supported 1,101 community health workers, village and other local leaders, and health center staff to detect and report suspected infectious disease cases using a mobile application. That paid off in November 2017 during an outbreak of bubonic and pneumonic plague. Community health workers alerted district authorities when plague first hit, and authorities summoned help from the World Health Organization.
Even in a midst of an epidemic, people still need essential services or help with other illnesses. It is critical that health care facilities continue operating. In Liberia, disruption to health services in the Ebola crisis led to a 53.6 percent increase in deaths by malaria and 59 percent for tuberculosis.
Strengthening health systems can be cost effective, too. The entire 2017–2018 health budget for Rwanda, which has made great strides in improving its near-universal health coverage, is approximately $224 million.
Those investments help improve readiness and delivery of care across a wide range of diseases and patient types and also help with delivery of care for chronic diseases. Meanwhile, as important as it is, CEPI is putting $25 million towards Nipah vaccines, which is only one of a myriad of diseases that cause outbreaks every year.
Finally, a key benefit of a strong, sustainable health system is that it can help prevent an outbreak from becoming an epidemic. Strong systems have the people and infrastructure in place to identify potential outbreaks early and respond to them quickly and effectively. Our strong health system is one reason why we haven’t had an infectious disease epidemic in a century in the United States.
For policy-makers in the United States and around the world seeking to prevent the next major outbreak of disease, vaccines are a key component of epidemic prevention. But investing now in building strong health systems that can prevent, identify, and effectively respond to disease outbreaks is an inexpensive, and extremely effective effort.
Marian Wentworth is the president and CEO of Management Sciences for Health, which is a nonprofit health organization focused on improving health of the world’s most vulnerable people.